Who is Entitled to Receive Michigan PIP Benefits?

A 5-part test

In Michigan, in addition to having an auto accident claim against the driver who causes injury in a car accident (third party), accident victims will also receive Michigan no fault “first party” or PIP benefits.

There is a five part test to see if there is entitlement to Michigan No Fault benefits following an auto accident under Michigan law.

The analysis below was originally part of a two day seminar presented by the injury attorneys at Michigan Auto Law for Michigan lawyers handling automobile accident cases in Dearborn, Michigan. The seminar was presented through the Institute for Continuing Legal Education (ICLE) and was intended to better educate small firm lawyers and solo practitioners throughout Michigan who handle car accidents, truck accidents, and motorcycle accidents on what other no fault benefits are available to their clients. A more comprehensive overview can also be found in our Michigan Auto Law no fault advice section.

Who is entitled to receive Michigan No Fault benefits after a Michigan auto injury accident?

No fault PIP benefits are available to any person who suffers personal injury in an automobile accident in Michigan, provided they are not the owner and operator of a car or truck operating without Michigan No Fault insurance.

Michigan car accident first-party claims, also known as Michigan PIP (personal injury protection) claims, are made to a claimant’s own no-fault insurer. The claimant’s insurer is required to pay Michigan No Fault benefits for expenses relating to a motor vehicle accident. These first-party car accident claims involve payments for medical expenses, wage loss, replacement services, mileage, survivor’s loss, funeral expenses, and attendant care, when applicable, if the injuries are serious enough.

There is one year to file an Application for Benefits under Michigan law with the no fault insurance company that has the highest priority to pay. There is also a strict one year statute to make sure that an incurred expense from a car accident, such as payment of a medical bill, is made or the claim will be time barred by law. The filing of a lawsuit by a Michigan car accident personal injury lawyer will toll this one year statute of limitations.

Five Part Test – PIP Entitlement – Burden on Plaintiff

§3105(1) provides: “Under personal protection insurance an insurer is liable to pay benefits for accidental bodily injury arising out of the ownership, operation, maintenance or use of a motor vehicle as a motor vehicle, subject to the provisions of this chapter.”

A Motorcycle is not a motor vehicle under Michigan no fault law. §3101(2)(c)

A Motorcyclist injured in a motorcycle accident can still qualify for Michigan no-fault if a motor vehicle is involved in the accident. §3101(2)(f). Blinded by car lights might be enough to create an issue of fact whether a motor vehicle was involved in a motorcycle accident.

Contact not required to be “involved” in an accident. Bromley v Citizens, 113 MA 131 (1982).

Certain vehicles with three or more wheels can be considered motor vehicles if operated on a public highway. Public Highway requires (1) open to vehicular travel (shoulder is – median is not) and (2) maintained by government.

Dual Purpose Vehicles (RVs) most likely need to be in operation (driving the vehicle) when the injury accident occurs to be considered a motor vehicle. Sleeping in trailer disqualified. McKenzie v ACIA, 458 M 214 (1998).

A single event that aggravates a pre-existing pathology can be injury under the no-fault act. See both Mollitor v Associated Truck Lines and DAIIE, 140 MA 431 (1985) (carpal tunnel not injury) and McKim v Home Insurance Co, 133 MA 694 (1984).

Test 3: Is the injury accidental? §3105(4)

To not be an accident, there must be (1) an intentional act and (2) intended injury. Thus, a person must intend the consequences, as well as the act, to be excluded for self-inflicted injury. Estate of Martin Roesch v DAIIE, 119 MA 578 (1982).

Intentional injury provisions of §3105(4) do not preclude intentional misconduct of another person. DAIIE v Higginbotham, 95 MA 213 (1980); however, many “intentional injury” cases have been dismissed due to test #4 the “arising out of” requirement.

Passenger who grabs hold of wheel of moving auto during a quarrel and who suffers personal injury is not disqualified from Michigan PIP benefits. Lock v Continental Insurance Company.

Test 4: The “arising out of” or causal nexus requirement

This test requires a sufficient causal nexus between the injury and the ownership, maintenance or use of a motor vehicle. Furthermore, the injury must be foreseeably identifiable with the normal use, maintenance and ownership of the vehicle [motor vehicle as a motor vehicle test]

Test 5: The motor vehicle as a motor vehicle.

Asphyxiation while plaintiff was sleeping in case is not covered because sleeping in vehicle is not using motor vehicle as motor vehicle. McKenzie v ACIA, 458 M 241 (1998); See generally, Clute v General American Assurance, 142 MA 640 (1985) on sleeping in vehicle.

Parent’s psychiatric emotional injuries and medical care following learning of child’s severe injury in auto accident is not covered; however, might be different if parent is in zone of danger. Williams v Citizens Mutual Ins, 94 MA 762 (1980)

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